Coma

With great effort at appearing nonchalant, Susan made her way over to the central desk. The charts were kept in a circular stainless steel file built into the counter top. With her left hand she began to turn the chart rack slowly. It squeaked painfully. Susan turned it more slowly. The squeak persisted.

“Can I help you?” asked June Shergood from behind Susan, causing her to start and to withdraw her hand as if she were a child caught at the cookie jar.

“I’d just like the chart,” said Susan, expecting some sour words from the nurse.

“What chart?” Shergood’s voice was pleasant.

“Nancy Greenly’s. I’m going to try to get an idea about her case so that I can participate in her care.”

June Shergood rummaged among the charts, coming up with Nancy Greenly’s. “You might find it easier to concentrate in there,” said Shergood with a smile, pointing toward a door.

Susan thanked her, welcoming the opportunity to withdraw. The door that Shergood had indicated opened into a tiny room ringed about with glass-faced, locked medicine cabinets. A counter top ran around three sides of the room, providing desk space. On the right was a sink, and in the left corner was the omnipresent coffeepot.

Susan sat down with the chart. Although Nancy Greenly had not been in the hospital for even two weeks, her chart was voluminous. That was usual for a case placed in the ICU. The elaborate, constant care generated reams of paper.

Susan took out the remains of her tuna sandwich and milk and poured herself a cup of coffee. Then she took out her notebook and removed a number of blank pages. She started to work. Unaccustomed to using a patient chart, she spent a few minutes figuring out its organization. The order sheets were first, followed by the graphs of the patient’s vital signs. Next was the history and physical examination dictated on the day of admission. The rest of the chart included the progress notes, the operative and anesthesia notes, the nurses’ notes, and the innumerable laboratory values, X-ray reports, and records of sundry tests and procedures.

Since she did not know what she was looking for, Susan decided to makes copious notes. At this early stage there was no way of determining what was going to be the important information. She started with Nancy Greenly’s name, age, sex, and race. Next she included the meager medical history attesting to the fact that Nancy Greenly had been a healthy individual. There were bits and pieces of family history, including reference to a grandmother who had had a stroke. The only illness of note in Nancy’s past was a case of mononucleosis at age 18, with an apparently uneventful recovery. The reviews of Nancy’s systems, including her cardiovascular and respiratory systems, were normal. Susan wrote down the laboratory values from her routine pre-op screen: the blood and urine were both normal She also wrote down the results of the pregnancy test, negative; various blood clotting studies, blood type, tissue type, chest X-ray, and EKG. There was also the chemistry profile, which included a wide battery of tests. Nancy Greenly’s reports were well within normal limits.

Susan ate the last of the tuna sandwich and washed it down with a slug of milk. Turning the pages of the operative section and locating the anesthesia record, she noted the pre-op medication: Demerol and Phenergan given at 6:45 A.M. by one of the nurses on Beard 5. The endotracheal tube was a number 8. Pentothal 2 grams given I.V. at 7:24

A.M. Halothane, nitrous oxide, and oxygen started at 7:25. The halothane concentration was initially 2 percent through the Fluotec Temperature Compensated Vaporizer. Within several minutes it was reduced to 1

percent. The nitrous oxide and oxygen flow rates were 3 liters and 2

liters per minute respectively. For muscle relaxation a 2 cc dose of 0.2

percent succinylcholine was given at 7:26 and a second dose at 7:40.

Susan noted that the blood pressure fell at 7:48 after maintaining a plateau of 105/75. The halothane percentage was reduced to 1/2 percent at that point, while the nitrous oxide and oxygen flow was changed to 2

and 3 liters. The blood pressure drifted back up to 100/60. Susan made a rough copy of the information which was graphed in the anesthesia record.

But from that point on the anesthesia record became hard to decipher.

As far as Susan could tell, the blood pressure and the pulse stayed about 100/60 and seventy per minute respectively. Although the heart rate stayed stable, there was some sort of variation in the rhythm, but Dr.

Billing had not described it.